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Tuesday, December 28. 2010

Gummy smile is an aesthetic disorder that can cause both men and women to be self conscious about their appearance and social interactions.

This condition is caused by the complex interaction between several facial muscles:

Levator Labii superioris alaeque nasi

Levator labii superioris

Zygomaticus minor

Risorius

I perform facelifts and am quite familiar with the interactions and positioning of these delicate muscles. A few units of botox, placed judiciously in the right position, can lower the upper lip a few millimeters and correct a "Gummy Smile”.

Allow your teeth to shine without being self conscious about over-exposure from your gums.

The procedure takes about 15 minutes to perform. There is no downtime, results are evident within 3-5 days, and may last up to 6 months.

The cost varies depending on how much Botox or Dysport is injected (Range $250-$500).

Tuesday, December 21. 2010

I performed several breast augmentaions with autologous fat during my fellowship in 2000 (BAMBI).

I then learned from Dr. Mel Shiffman and others that the transfered fat can rarely become calcified. The calcification itself is not an issue as it is microscopic but it MAY mask an underlying breast cancer. Five to seven percent of American women develop breast cancer during their lifetime.

I hope that we can develop better modalities to distinguish calcification from fat transfer to the breast from the malignant calcification that is sometimes seen in breast cancer. Until then I recommend to proceed with caution.

Below is an update on fat transfer to the breast by one of the leading doctors in the field:

Update on Cell-Assisted Lipotransfer

by Jeffrey Frentzen

Kotaro Yoshimura, MD

Combining stem cells and liposuctioned fat—the latest permutation of doing fat transfer to the breast for augmentation—is one topic that is talked about in sometimes heated terms in the physicians' meetings, physician's practice, and at the dinner table.

In 2007, we first heard about a new stem cell-assisted treatment for breast augmentation that was developed by the Department of Plastic Surgery at the University of Tokyo. The procedure, dubbed Cell-Assisted Lipotransfer (CAL) by its creator, Kotaro Yoshimura, MD, also involves the use of adipose-derived stem cells that are isolated from liposuction aspirates. In this case, though, the processed cells are added to additional aspirated fat and then injected into the breasts.

Yoshimura is an assistant professor at the Department of Plastic Surgery in the University of Tokyo.

The CAL approach is different from other approaches tried in the United States, such as the LipoStructure procedure pioneered by Sydney Coleman in the United States. Using the CAL procedure, a single treatment can successfully increase breast volume by 120 mL to 160 mL—roughly two cup sizes (5 cm to 7 cm). For patients seeking to augment their breasts by 300 mL, the treatment needs to be performed twice; and for augmentations exceeding 300 mL, a combination of an implant and the stem cell technique is used to achieve the desired results.

Highlights of this procedure include the following:

The patient is under general anesthesia. A saline solution containing a weak local anesthetic and a vasoconstrictor is injected into the areas where fat is to be suctioned. This softens the treated area and constricts the blood vessels.

Via a tiny incision in the skin, a narrow metallic tube is inserted and a liposuction pump is used to suction subcutaneous fat.

Stem cells are obtained from parts of the aspirated fat and mixed with the fat to be reinjected.

The fat mixed with stem cells is transplanted by a special injector for transplantation, small area by small area over a wide area in order to prevent lumpiness.

Mild swelling and pain that occurs on the suctioned area or the injected area goes away in around 1 month.

I spoke with Yoshimura to get an update on the status of CAL in Japan and to find out if his procedure would be imported to the United States anytime soon.

PSP: Please report on clinical trials under way in the United States.

Yoshimura: To my knowledge, no clinical trials regarding adipose stem/progenitor cells have been done in plastic surgery in the US.

PSP: How many patients have you treated with the stem cell/fat tissue procedure, and what are the results, overall?

Yoshimura: More than 400 patients have been done by the end of 2009. Overall results are satisfactory and encouraging so far. Although clinical outcomes are very variable among patients and many factors—including operator factors and patients' factors—affect clinical outcomes, quality and naturalness of augmented tissue is excellent. Preserved tissue volume appeared to be much better than conventional methods.

PSP: What are the differentiating age/race/gender/demographics of the patients? What percentage received each procedure according to breast, face, hip, etc?

Yoshimura: The frequent age is between 30 to 50 years old, almost all are Japanese, and all are female other than four males. The procedures break down as 83% breast (55% augmentation, 15% implant replacement, and 13% reconstruction), 15% face, and 2% others. But there have been many breast reconstructions and facial reconstructions. Among the latter are acquired defects, Parry-Romberg disease, Lupus erythematosus, scleroderma, etc.

PSP: What were some outstanding characteristics of the patients treated in the breast? The patients treated in the face and on the hip?

Thursday, December 9. 2010

Very few things in life truly upset me. Smoking and the morbidity and mortality that it causes make my blood boil. I believe that we have failed as a society when we allow smoking to kill over 500000 people a year in the US alone. The figure is over 10 million deaths a year worldwide. That is almost 2 Holocausts a year directly related to smoking.

Smoking also ages the skin and causes degeneration of Collagen and Elastic fibers. It causes sagging of the skin and raises the risks of various skin cancers by lowering the immune system.

A recent study by the FDA found that even transient contact with cigarette smoke causes damage; even at a cellular level by damaging the DNA.